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Maine rates for HCPCS L3977

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.30 / $1,223.21 / $1,223.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,792.35 / $2,322.15 / $4,304.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.35 / $1,177.02 / $1,177.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,335.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $975.01 / $1,335.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.65 / $1,631.65 / $1,631.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,134.71 / $1,223.21 / $1,223.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.25 / $1,005.38 / $2,312.05